Magnetic resonance imaging should be the first‐line imaging modality for investigating suspected proximal hamstring avulsion injuries

Abstract Purpose The purpose of the study was to evaluate how the initial diagnostic tool used—specifically ultrasound (US) or magnetic resonance imaging (MRI)—for diagnosing proximal hamstring avulsion injury affects the delay before surgery and, secondarily, the outcomes of these injuries. Methods This was a retrospective analysis of prospectively collected data (2012–2020). It targeted patients primarily treated for proximal hamstring avulsion injury. It included all patients with a preoperative US and/or MRI. Patients were divided into two groups based on the initial diagnostic tool used (US‐first vs. MRI‐first groups). The primary outcomes measure was the time from initial injury to surgical intervention (surgical delay). The secondary outcomes were the Parisien Hamstring Avulsion Score, as well as the activity level as measured by the University of California, Los Angeles (UCLA) Activity Scale and Tegner Activity Scale. Results The analysis included 392 patients with a mean age of 43.8 ± 13.6 years for the MRI‐first group and 47.6 ± 12.0 years for US‐first group. Patients in the MRI‐first group had a significantly shorter median time from injury to surgery of 20.0 days (interquartile range IQR: 11.0–61.0) compared to 30 days (IQR: 18–74) in the US‐first group. At the final follow‐up (4.2 ± 2.2 years for the MRI‐first group and 5.1 ± 1.9 years for the US‐first group), the MRI‐first group had significantly higher mean Tegner Activity Scale and UCLA scores than the US‐first group: The Tegner Activity Scale was median 5 (IQR: 3–7) for the MRI‐first group versus median 4 (IQR: 2–6) for the US‐first group ( p < 0.05). The UCLA scores were 7.9 ± 2.4 for the MRI‐first group compared to 7.3 ± 2.4 for the US‐first group ( p < 0.05). This difference was more pronounced when comparing the MRI‐first group with the patient‐false negative initial ultrasound. No difference was found regarding the Parisien Hamstring Avulsion Score. Conclusion MRI as the initial diagnostic tool for proximal hamstring avulsion injury is associated with a shorter time to surgery and better postoperative outcomes in Tegner Activity Scale and UCLA scores, compared to US. Level of Evidence Level III.